Treatment for Aspergers Disorder

By MARINA BENJAMEN, PH.D.

There are a wide variety of helpful treatments for Aspergers Disorder that help an individual learn better social skills and communication cues, to help them be able to interact socially more naturally. At present, like most mental disorders, there is no cure for Aspergers Disorder. But by focusing on learning ways to cope with the symptoms and pick up on social cues, most individuals with Aspergers Disorder lead fairly typical lives, with close friends and loved ones.

Psychosocial Interventions for Aspergers

According to the National Institute of Neurological Disorders and Stroke, the ideal treatment for Aspergers coordinates therapies that address the three core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness. There is no single best treatment package for all children with AS, but most professionals agree that the earlier the intervention, the better. An effective treatment program builds on the childs interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the childs attention in highly structured activities, and provides regular reinforcement of behavior. It may include social skills training, cognitive behavioral therapy, medication for co-existing conditions, and other measures. Individual psychotherapy to help the individual learn social skills training, to better detect social cues, and how to deal with the emotions surrounding the disorder Parent education and training Behavioral modification Social skills training Educational interventions

Psychiatric Medications
For hyperactivity, inattention and impulsivity: Psychostimulants (methyphenidate, dextroamphetamine, metamphetamine), clonidine, Tricyclic Antidepressants (desipramine, nortriptyline), Strattera (atomoxetine) For irritability and aggression: Mood Stabilizers (valproate, carbamazepine, lithium), Beta Blockers (nadolol, propranolol), clonidine, naltrexone, Neuroleptics (risperidone, olanzapine, quetiapine, ziprasidone, haloperidol) For preoccupations, rituals and compulsions: SSRIs (fluvoxamine, fluoxetine, paroxetine), Tricyclic Antidepressants (clomipramine) For anxiety: SSRIs (sertraline, fluoxetine), Tricyclic Antidepressants (imipramine, clomipramine, nortriptyline)

With effective treatment, children with Aspergers disorder can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.

Symptoms of Aspergers Disorder

By MARINA BENJAMEN, PH.D.

Aspergers Disorder is a syndrome that typically appears first inchildhood, and is primarily characterized by a persons difficulty in everyday social interactions with others. For instance, a person with Aspergers may engage in long-winded, one-sided conversations without noticing or caring about the listeners interest. They also often lack usual nonverbal communication skills, such as engaging in eye contact with others theyre talking to, or failing to react and empathize with other peoples stories and conversation. This may make them seem insensitive, although that is rarely the case. They may have a hard time reading other people or understanding humor. Adults, too, may have Aspergers, as often the disorder is not properly diagnosed in childhood. Aspergers is considered the mildest, least severe form of autism. The following five criteria primarily characterize Aspergers Disorder. 1. A significant, ongoing impairment in social interactions with others, as demonstrated by at least two of the following symptoms: Significant difficulty in the use of multiple nonverbal behaviors such as the lack of eye contact, few facial expressions, awkward or clumsy body postures and gestures Failure to develop friendships with other children of the same age Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) Failure to express appropriate and corresponding social or emotional reactions, such as when conversing or playing with others. For example, a child who shows little or no reaction, feelings or empathy to another child talking with them.

2. Restricted and repetitive patterns of behavior, interests, and activities, as shown by at least one of the following symptoms: A significant and encompassing preoccupation or obsession with one or two restricted topics, that is abnormal either in intensity, subject or focus (such as baseball statistics or the weather) Seemingly inflexible adherence to specific routines or rituals that serve little purpose

Repetitive motor mannerisms. For example, hand or finger flapping or twisting, or complex whole-body movements. A persistent preoccupation with parts of objects

3. The set of symptoms causes significant impairment in social, occupational, or other important areas of functioning. 4. There is no significant general delay in language (e.g., single words used by age 2, communicative phrases used by age 3). 5. There is no significant delay in cognitive development (such as reading or math skills) or in the development of age-appropriate self-help skills, behavior, and curiosity about the environment in childhood.

Early Signs of Aspergers Disorder

Its important to note that a person with Aspergers disorder has no general delay in language acquisition, cognitive development and adaptive behavior (other than in social interaction). This contrasts with typical developmental accounts of autistic children who show marked deficits and deviance in these areas prior to age 3. Other common descriptions of the early development of individuals with Aspergers include certain characteristics that may be helpful in identifying it earlier on. These characteristics include: A certain precociousness in learning to talk (e.g., He talked before he could walk!) A fascination with letters and numbers. In fact, the young child may even be able to decode words, with little or no understanding of them (hyperlexia) The establishment of close relationships to family members, but inappropriate relationships or interactions with friends and others (rather than withdrawal or aloofness as in autism). For example, in Aspergers the child may attempt to initiate contact with other children by hugging them or screaming at them and then puzzle at their responses.

These behaviors are sometimes described for higher-functioning autistic children as well, albeit much more infrequently than they are for children with Aspergers.

All About Aspergers Disorder

By MARINA BENJAMEN, PH.D.

The essential features of Aspergers Disorder are severe and sustained impairment in social interactions with others, and the development of restricted, repetitive patterns of behavior, interests, and activities. A person with Aspergers often appear to lack empathy toward others, have difficulty with nonverbal behavior (such as making eye contact or having facial expressions), and may show an intense obsession with very defined, narrow topics of interest.

Some people with Aspergers may engage in long-winded, one-sided conversations with others, without regard to the other persons interest in what theyre saying. Sometimes a person may speak in a monotone voice or unusually fast, and may have odd body postures or gestures. Click here for the specific symptoms used to diagnose Aspergers Disorder. In contrast to autism, there are no clinically significant delays in language (e.g., single words are used by age 2 and communicative phrases are used by age 3). In addition, there are no clinically significant delays in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

Prevalence
Information on the prevalence of Aspergers Disorder is limited, but it appears to be more common in males.

Course
Aspergers Disorder appears to have a somewhat later onset than Autistic Disorder, or at least to be recognized somewhat later. Motor delays or motor clumsiness may be noted in the preschool period. Difficulties in social interaction may become more apparent in the context of school. It is during this time that particular idiosyncratic or circumscribed interests (e.g., a fascination with train schedules) may appear or be recognized as such. As adults, individuals with the condition may have problems with empathy and modulation of social interaction. This disorder apparently follows a continuous course and, in the vast majority of cases, the duration is lifelong.

Familial Pattern
Although the available data are limited, there appears to be an increased frequency of Aspergers Disorder among family members of individuals who have the disorder

Aspergers Syndrome
By MARGARITA TARTAKOVSKY, M.S.

Aspergers Disorder also known as Aspergers Syndrome or just AS is a mild form of autism, recognized as a mental health concern that sometimes requires treatment. Aspergers is usually diagnosed inchildhood or as a young teenager, and is characterized by social impairment, isolation, and what others might see as eccentric behavior. The disorders name comes from Hans Asperger, an Austrian physician who first described the syndrome in 1944.

Aspergers: Impairments in Social Interactions with Others

Although the social criteria for Aspergers Disorder (also known as Aspergers Syndrome or AS) and autism are identical, AS usually involves fewer symptoms and presents differently than autism. Individuals with Aspergers Disorder often isolate themselves, but theyre still aware of the presence of others, even though the way they approach people can be inappropriate and even peculiar. For example, they might have a one-sided and long-winded conversation with a person usually an adult about an unusual and narrow topic. Also, although individuals with Aspergers are often self-described loners, they usually express great interest in making friends and meeting people. Unfortunately, their awkward approach, insensitivity to others feelings and odd facial expressions and body language (e.g., signs of boredom, quick to leave, avoiding eye contact or staring inappropriately) make developing relationships difficult. This can lead to chronic frustration. Even worse, some individuals get so upset that they develop symptoms of depression, which may require treatment, including medication. Individuals with AS often also display inappropriate emotional aspects of social interactions. They can come off as being insensitive. They might appear to lack empathy or to disregard another persons expressions and gestures altogether. However, people with

AS usually are able to describe other peoples emotions and intentions theyre just unable to act on this knowledge in an intuitive and spontaneous way, so they end up losing the rhythm of the interaction. Because they have such a poor sense of intuition and spontaneity, people with AS rely on formal, rigid rules of behavior, making them appear inappropriately and overly formal in social situations. Some of these symptoms also appear in individuals with higher-functioning autism, though perhaps to a lesser extent. Most autistic people seem withdrawn and unaware of or uninterested in other people.

Aspergers: Impairments in Communication with Others

Unlike autistic individuals, those with AS dont usually have significant speech problems, but their language and speech skills still differ from people without the disorder. As a whole, people with AS have an odd way of using language. Specifically, their communication differs in three major ways. 1. People with AS dont have quite the degree of rigid inflection and intonation as autistic individuals, but they still tend to speak in a monotone. Pitch typically lacks variation and is simply peculiar. They might talk too loudly or too formally. They tend to misunderstand the nuances of language, such as taking a sarcastic remark seriously or not grasping a joke or a metaphor. 2. They may go off on tangents during a conversation and their speech can seem incoherent. Even though in some cases this symptom might mean a possible thought disorder, its more likely that the incoherent speech is a result of their onesided, egocentric conversational style, inability to provide background information, clearly distinguish changes in topic and tendency to express their inner thoughts. 3. Some experts view the long-winded and one-sided conversations as one of the most prominent differential features of the disorder. The child or adult may talk incessantly, usually about their favorite subject, often completely disregarding whether the listener is interested, engaged or trying to interject a comment, or change the subject. Despite such long-winded monologues, the individual may never come to a point or conclusion. Usually the other person cant get a word in and is unable to change the conversation. Even though its possible that these symptoms stem from significant deficits in pragmatics skills or a lack of insight into, and awareness of, other peoples expectations, the challenge is to understand them developmentally as strategies of social adaptation.

Aspergers: Restricted and Repetitive Patterns of Behavior, Interests and Activities

The DSM-IV criteria for Aspergers Disorder and autism are identical, requiring the presence of at least one symptom from this category. The most commonly seen symptom in AS is an all-absorbing preoccupation with an unusual and very narrow topic (e.g., snakes, names of stars, maps, TV guides, railway schedules). A person with AS will usually know the topic inside and out and want to talk about it all the time during social interactions. Although this symptom may not be easily recognized in children, since strong interests in one topic are so common, it may become more salient with age, as interests shift to odd and narrow topics. The topics may change every year or two, but the intensity with which they are studied remains the same. Individuals with AS tend to have rigid routines and dislike change. For instance, children may be very particular about how they eat.

Aspergers: Physical Clumsiness

Delayed motor development that is, the ability to move ones physical body with ease and grace is an associated feature, although its not a required criterion for diagnosis of Aspergers Disorder. Individuals with AS may have a history of delayed motor skills such as riding a bike, catching a ball or opening jars. They are often awkward, with a rigid walk, odd posture and problems with visual-motor coordination. Although this differs from motor development in autistic children, whose motor skills often are a relative strength, it is somewhat similar to patterns seen in older autistic individuals. The similarity might stem from different underlying factors, however, such as psychomotor deficits in AS and poor body image and sense of self in autism. This highlights the importance of describing this symptom in developmental terms.
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Aspergers Disorder
By HAROLD COHEN, PH.D.

Aspergers Disorder is the term for a specific type of pervasive developmental disorder which is characterized by problems in development of social skills and behavior. In the past, many children with Aspergers Disorder were diagnosed as having autism, another of the pervasive developmental disorders, or other disorders. While autism and Aspergers have certain similarities, there are also important differences. For this reason, children suspected of having these conditions require careful evaluation. In general, a child with Aspergers Disorder functions at a higher level than the typical child with autism. For example, many children with Aspergers Disorder have normal intelligence. While most children with autism fail to develop language or have language delays, children with Aspergers Disorder are usually using words by the age of two, although their speech patterns may be somewhat odd.

Most children with Aspergers Disorder have difficulty interacting with their peers. They tend to be loners and may display eccentric behaviors. A child with Aspergers, for example, may spend hours each day preoccupied with counting cars passing on the street or watching only the weather channel on television. Coordination difficulties are also common with this disorder. These children often have special educational needs. Although the cause of Aspergers Disorder is not yet known, current research suggests that a tendency toward the condition may run in families. Children with Aspergers Disorder are also at risk for other psychiatric problems including depression, attention deficit disorder,schizophrenia, and obsessivecompulsive disorder. Child and adolescent psychiatrists have the training and expertise to evaluate pervasive developmental disorders like autism and Aspergers Disorder. They can also work with families to design appropriate and effective treatment programs. Currently, the most effective treatment involves a combination of psychotherapy, special education, behavior modification, and support for families. Some children with Aspergers Disorder will also benefit from medication. The outcome for children with Aspergers Disorder is generally more promising than for those with autism. Due to their higher level of intellectual functioning, many of these children successfully finish high school and attend college. Although problems with social interaction and awareness persist, they can also develop lasting relationships with family and friends.

Aspergers Syndrome
By MARGARITA TARTAKOVSKY, M.S.

Aspergers Disorder also known as Aspergers Syndrome or just AS is a mild form of autism, recognized as a mental health concern that sometimes requires treatment. Aspergers is usually diagnosed inchildhood or as a young teenager, and is characterized by social impairment, isolation, and what others might see as eccentric behavior.

The disorders name comes from Hans Asperger, an Austrian physician who first described the syndrome in 1944.

Aspergers: Impairments in Social Interactions with Others

Although the social criteria for Aspergers Disorder (also known as Aspergers Syndrome or AS) and autism are identical, AS usually involves fewer symptoms and presents differently than autism. Individuals with Aspergers Disorder often isolate themselves, but theyre still aware of the presence of others, even though the way they approach people can be inappropriate and even peculiar. For example, they might have a one-sided and long-winded conversation with a person usually an adult about an unusual and narrow topic. Also, although individuals with Aspergers are often self-described loners, they usually express great interest in making friends and meeting people. Unfortunately, their awkward approach, insensitivity to others feelings and odd facial expressions and body language (e.g., signs of boredom, quick to leave, avoiding eye contact or staring inappropriately) make developing relationships difficult. This can lead to chronic frustration. Even worse, some individuals get so upset that they develop symptoms of depression, which may require treatment, including medication. Individuals with AS often also display inappropriate emotional aspects of social interactions. They can come off as being insensitive. They might appear to lack empathy or to disregard another persons expressions and gestures altogether. However, people with AS usually are able to describe other peoples emotions and intentions theyre just unable to act on this knowledge in an intuitive and spontaneous way, so they end up losing the rhythm of the interaction. Because they have such a poor sense of intuition and spontaneity, people with AS rely on formal, rigid rules of behavior, making them appear inappropriately and overly formal in social situations. Some of these symptoms also appear in individuals with higher-functioning autism, though perhaps to a lesser extent. Most autistic people seem withdrawn and unaware of or uninterested in other people.

Aspergers: Impairments in Communication with Others

Unlike autistic individuals, those with AS dont usually have significant speech problems, but their language and speech skills still differ from people without the disorder. As a whole, people with AS have an odd way of using language. Specifically, their communication differs in three major ways. 1. People with AS dont have quite the degree of rigid inflection and intonation as autistic individuals, but they still tend to speak in a monotone. Pitch typically lacks variation and is simply peculiar. They might talk too loudly or too formally. They tend to misunderstand the nuances of language, such as taking a sarcastic remark seriously or not grasping a joke or a metaphor.

2. They may go off on tangents during a conversation and their speech can seem incoherent. Even though in some cases this symptom might mean a possible thought disorder, its more likely that the incoherent speech is a result of their one-sided, egocentric conversational style, inability to provide background information, clearly distinguish changes in topic and tendency to express their inner thoughts. 3. Some experts view the long-winded and one-sided conversations as one of the most prominent differential features of the disorder. The child or adult may talk incessantly, usually about their favorite subject, often completely disregarding whether the listener is interested, engaged or trying to interject a comment, or change the subject. Despite such long-winded monologues, the individual may never come to a point or conclusion. Usually the other person cant get a word in and is unable to change the conversation. Even though its possible that these symptoms stem from significant deficits in pragmatics skills or a lack of insight into, and awareness of, other peoples expectations, the challenge is to understand them developmentally as strategies of social adaptation.

Aspergers: Restricted and Repetitive Patterns of Behavior, Interests and Activities

The DSM-IV criteria for Aspergers Disorder and autism are identical, requiring the presence of at least one symptom from this category. The most commonly seen symptom in AS is an all-absorbing preoccupation with an unusual and very narrow topic (e.g., snakes, names of stars, maps, TV guides, railway schedules). A person with AS will usually know the topic inside and out and want to talk about it all the time during social interactions. Although this symptom may not be easily recognized in children, since strong interests in one topic are so common, it may become more salient with age, as interests shift to odd and narrow topics. The topics may change every year or two, but the intensity with which they are studied remains the same. Individuals with AS tend to have rigid routines and dislike change. For instance, children may be very particular about how they eat.

Aspergers: Physical Clumsiness

Delayed motor development that is, the ability to move ones physical body with ease and grace is an associated feature, although its not a required criterion for diagnosis of Aspergers Disorder. Individuals with AS may have a history of delayed motor skills such as riding a bike, catching a ball or opening jars. They are often awkward, with a rigid walk, odd posture and problems with visual-motor coordination. Although this differs from motor development in autistic children, whose motor skills often are a relative strength, it is somewhat similar to patterns seen in older autistic individuals. The similarity might stem from different underlying factors, however, such as psychomotor deficits in AS and poor body image and sense of self in autism. This highlights the importance of describing this symptom in developmental terms.

Adult Aspergers: The Relief of A Diagnosis

By MARIE HARTWELL-WALKER, ED.D.

The following are criteria for Aspergers that have been excerpted from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): 1. Qualitative impairment in social interaction, as manifested by at least two of the following: o Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction Failure to develop peer relationships appropriate to developmental level A lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) lack of social or emotional reciprocity

o o

2. Restricted repetitive & stereotyped patterns of behavior, interests and activities 3. The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning. 4. There is no clinically significant general delay in language

5. There is no clinically significant delay in cognitive development or in the

development of age-appropriate self-help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

They are often physically awkward and socially tactless.

Youve probably known quite a few. Maybe they are even in your family. Theres that brilliant professor you had in college who looked at his desk the entire time he was talking to you and whose office was so overflowing with stuff there was nowhere for a visitor to sit. How about your brother-in-law the mechanic, whose work is superb but who insists on describing in minute detail exactly what he did to fix your car and doesnt seem to notice all your hints that youre trying to leave already! What about your uncle or cousin or the sister of your best friend who is so socially awkward that you squirm with discomfort whenever they show up at an event, wondering what theyll do next to embarrass themselves? They are often physically awkward and socially tactless. They seem to be perfectionists but often live in chaos. They know more about some obscure or highly technical subject than seems possible and go on and on about it. They may seem to lack empathy, and are often accused of being stubborn, selfish, or even mean. They can also be extremely loyal, sometimes painfully honest, highly disciplined and productive in their chosen field, and expert at whatever they decide to be expert at. They are the Aspies, adults with Aspergers Syndrome. The number of adults with Aspergers is still difficult to determine. The syndrome wasnt even officially acknowledged in the DSM until 1994, even though it was described by Hans Asperger in 1944. The result? Many older adults werent diagnosed or helped as children. Teachers found them exasperating because they were so disorganized and uneven in their academic performance despite often being clearly bright. Other kids considered them weird and either bullied them or ignored them. As adults, they are only now discovering that there is a reason theyve had difficulties with relationships their entire lives. For many, having a diagnosis is a relief. I never could figure out what other people want, says Jerome, one of my Aspie clients. People seem to have some kind of code for getting along that is a mystery to me. Jerome is a brilliant chemist. He has the respect of his colleagues but he knows that hes not well-liked. The finely tuned intuition he uses to do research breaks down completely in relationships. I know Im well-regarded in my work. As long as were talking about a research problem, everything is fine. But as soon as people start doing that small talk stuff, Im lost. Its good to have a name for it. At least I know theres a reason. Jerome is now starting to put the same intelligence he uses in his lab to learning better social skills. For him, its an academic problem to solve. Like many other Aspies, he wants to get along and have friends. Hes highly motivated to learn the rules most people take for granted. He just never understood what those rules were. Having the diagnosis has given him new energy for the project. The press coverage of the syndrome of the last several years has been very helpful as well.

I was working on a highly technical engineering project with a new guy last week. In the middle the morning, he put down his pencil, looked at me and said, You have Aspergers, dont you. Ted was explaining a recent encounter to me. I got real nervous, thinking he was going to leave. What did you say? I asked. Well. I know now thats my problem so I just said he was right. And you know what he said? He said, I thought so and told me I could relax because he works with another guy who has the same thing. We had a great morning solving the problem. That wouldnt have happened even a few years ago. I would have upset him somehow without understanding why. He would have gone back to his company thinking I was some kind of jerk. Things are just better now that theres some understanding out there. Having the diagnosis has also saved more than a few marriages. Now that the kids are grown, Judy was ready to separate from her husband of 27 years when she first came to therapy. If Al and Tipper Gore could do it after 40 years of marriage, I figured I could manage it too. I dont know what their problems were but I was just exhausted. I felt like Id been single-parenting our two kids forever. Actually, I felt like I had three kids. Most of my friends couldnt figure out what I saw in a guy who could only talk about one thing and who would rudely disappear in the middle of a social evening. He never seemed to be able to understand any of our feelings. Our finances were always a mess because he would lose track of bills. Yes, he was really sweet to me in our private life and hes always been great about doing things like building the kids a tree house that was really, really cool. But it became harder and harder to see that as a fair exchange for all the times I had to smooth things over because of something he did or didnt do that bothered someone. Then my daughter emailed me an article about Aspergers. It changed everything. I realized he wasnt deliberately making life so hard. He couldnt help it. As soon as he took an Aspie quiz online, he saw it was true. He does love us. He didnt want the family to fall apart. He went right out and found a therapist who works with adults with Aspergers. Hes far from perfect but hes honestly trying. Hes even apologized to the kids for not being more involved while they were growing up. I cant ask for more than that. A diagnosis is primarily used to drive treatment decisions and to make it easier for clinical people to communicate with each other. But in cases like these, it can also be an enormous comfort to the individual and their families. As long as someone with Aspergers feels like they are being blamed or criticized for something they dont even understand, they can only be defensive or bewildered. When the people around them feel offended or disrespected, they can only get exasperated, argue, or write them off. But when the thing that makes a relationship difficult is named and understood, it becomes a problem that can be worked on together. That shift can change everything.